<p> Application form for an authorisation to use frequencies for industrial equipment testing</p><p>Applications should be sent to Arcep via a letter signed and accompanied by this form, duly completed.</p><p>This form is dedicated to frequency requests for industrial equipment testing such as unmanned aircraft systems, communication systems for defense purpose, etc.</p><p>1. SUMMARY OF THE APPLICATION FOR INDUSTRIAL EQUIPMENT TESTING</p><p>1.1. Name of the company applying for the authorisation</p><p>1.2. Frequencies requested</p><p>Frequency band(s) Frequency bandwidth desired Minimum bandwidth required </p><p>1.3. Location and expected duration of the industrial equipment testing</p><p>Location requested Duration requested Start and end dates expected from to </p><p>1.4. General description of the industrial equipment testing (Context and objectives, technologies to be used, industrial or institutional set-up, any partnerships, etc.)</p><p>Version 1.1 Update: 25/05/2016 Page 1/4 Application form for an authorisation to use frequencies for industrial equipment testing</p><p>2. INFORMATION ABOUT THE APPLIQUANT</p><p>2.1. Administrative informations about the appliquant</p><p>Corporate name </p><p>Adress </p><p>Postal code City </p><p>France : Code Siret Code NAF </p><p>Other countries: Registration number </p><p>2.2. Reference technical contact</p><p>Name </p><p>Fonction </p><p>Phone number Fax </p><p>Email </p><p>2.3. Paying service (if different from applicant)</p><p>Corporate name </p><p>Billing address </p><p>Postal code City </p><p>Contact point </p><p>Phone number Fax </p><p>Email </p><p>Version 1.1 Update: 25/05/2016 Page 2/4 Application form for an authorisation to use frequencies for industrial equipment testing</p><p>3. TECHNICAL DESCRIPTION OF THE INDUSTRIAL EQUIPMENT TESTING </p><p>The applicant is invited to complete the following information necessary for the application instruction bu Arcep.</p><p>Assignation Pre coordination type Initial Renewal Company</p><p>Emission central frequencies (MHz) (specify the minimum number of frequencies required to operate the system - generic channel)</p><p>Geographical site characteristics Country or Region Department City (+ Code INSEE) Locality Geographic Longitude: coordinates (WGS84) Latitude: Polygone coordinates or terminal location area Ground Altitude / Sea level (m) (NGF ou NMM) Antenna high (phase center) above ground (m) Transmitter / receiver features Reference of the equipment manufacturer Peak power of the transmitter before antenna (dBW) Equivalent isotropic radiated peak power (EIRP) (dBW) Modulation type (s) Threshold of -103 (dBm) Threshold of -106 (dBm) Requested Bandwidth (MHz) Throughput of the link (Mbits/s) Antenna features Antenna type (reflector dish, electronic scanning, etc.) Antenna diagram type (omnidirectional, beam, etc.) Antenna gain (dBi) Width antenna pattern (°) (in azimuth and elevation at -3 dB of the max power) Polarization</p><p>Version 1.1 Update: 25/05/2016 Page 3/4 Application form for an authorisation to use frequencies for industrial equipment testing</p><p>Attach the antenna radiation patterns </p><p>Figure 1 : antenna radiation patterns with horizontal polarization </p><p>.</p><p>Figure 2 : antenna radiation patterns with vertical polarization </p><p>Operating and coordination parameters Purpose of the station :</p><p>Instrumental range (km) Period of use Start date Pre-coordination requirement (if any)</p><p>Observations Experimental period (1 year maximum, renewable up on request only) </p><p>Provide a map of the service area of the mobile terminals.</p><p>Version 1.1 Update: 25/05/2016 Page 4/4</p>